Improving Survival in Patients with Decompensated Cirrhosis

About 60% of patients with decompensated disease have oesophageal varices. One third of these patients will experience variceal bleed. Each bleeding episode compromises the decompensated state and is associated with a 20% to 30% mortality. Bleeding from ectopic varices is rare but is generally massive and life threatening. The first two articles, " Clin-icopathological features and treatment of ectopic varices with portal hypertension " and " Application of endoscopy in improving survival of cirrhotic patients with acute variceal hemorrhage " discuss the management of variceal bleeding in cir-rhotic patients. " Improved survival with the patients with va-riceal bleed " is a review article on how new treatment modalities have improved the outlook of patients with bleeding oesophageal varices. The hepatorenal syndrome (HRS) signifies advanced liver failure and is a bad prognostic factor in patients with decompensated cirrhosis. Management of this condition is discussed in " Management of renal failure and ascites in patients with cirrhosis ". One of the features of decompensated liver disease is the occurrence of recurrent or resistant ascites. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for refractory ascites and HRS at the expense of hepatic encephalopathy and may offer an effective bridge to liver transplantation, by improving short and medium term survivals, as discussed in " Role of TIPS in improving survival of patients with decompensated liver disease ". Bacterial infection is responsible for up to a quarter of the deaths of patients with decompensated liver disease. " Prevention and management of bacterial infections in cirrhosis " discuss the high index of suspicion that is needed to prevent bacterial infections in patients with decompensated cirrhosis. These patients are immunologically compromised, and prophylactic antibiotics can prevent fatal septicemia and HRS in those with gastrointestinal bleeding. Current thoughts on how to deal with the neuropsychiatric complication of cirrhosis are discussed in " Management of hepatic encephalopathy ". Cardiomyopathy, hepatopulmonary syndrome , portopulmonary hypertension and right-sided hy-drothorax complications that are often overlooked in patients with decompensated liver disease are discussed in " Management of cardiopulmonary complications of cirrhosis ". Decompensated liver cirrhosis has been traditionally considered as a prototype of hemorrhagic coagulopathy, and routinely performed coagulation profile is abnormal in the majority of these patients. In " Management of coagulopathy in patients with decompensated liver disease " , the authors discussed recent thoughts on coagulation in end-stage liver disease. The related article entitled " Determination of ADAMTS13 …